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OBJECTIVES: To establish the prevalence and distribution of witnesses, victims, and perpetrators of different types of violence in the general population and the proportion of victims consulting health services or reporting the incident to authorities. METHODS: Cross sectional survey of a random sample of 3007 inhabitants between the ages of 15 and 60 in the city of Bogotá, Colombia, in 1997, based on a face to face interview. RESULTS: Age adjusted past year prevalence of witnesses, victims, and perpetrators of physical aggression was 61%, 27%, and 27%, respectively, while lifetime prevalence of witnesses, victims, and perpetrators of assault with a weapon in this population reached 70%, 55%, and 5.8%. Between 11% and 67% of the victims consulted a health service and less than 32% reported the incident to an authority. Those involved in most types of physical violence tended to be young, male, from lower middle social classes, with some degree of secondary education, and single or divorced. CONCLUSIONS: Prevalence of witnesses and victims of violence in this sample appears to be high, while perpetrators constitute a small proportion. Violence is not equally distributed throughout the population suggesting the possibility of identifying a population at higher risk for the development of intervention programmes.

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OBJECTIVE: Estimate the magnitude of the problem of violence in intimate relationships affecting women in Santa Fe de Bogotá, Colombia, and identify the factors related to the risk of being battered. METHODS: The data analyzed were collected between September 1998 and September 1999 from interviews with 3,971 women who had a child less than 6 months old. The women interviewed were ones using public health services in the Suba area of Bogotá, either for pediatric attention (well-baby services, vaccination, an ill child) or for childbirth. Out of the 3,971 women, 10 of them declined to participate, and 804 of them were not in an intimate relationship and were excluded from the analyses. RESULTS: Of the 3,157 participants, 26.5% of them reported that their current partner had slapped or pushed them, and 13.3% reported they had been hit with a fist, kicked, hit with some object, or beaten, or threatened with a knife or gun. In addition, 26.2% of the women said that their partner imposed some prohibition on them (on social activities, work, family planning, etc.). In the bivariate analyses, violence was significantly associated with: less schooling and lower income (P < 0.001), having more children (P < 0.001), a longer period of time living with the partner (P < 0.001), more frequent conflict with the partner (P < 0.001), not having other family members living in the home (P < 0.01), a history of abuse in the family of origin (P < 0.001), and prohibitions imposed by the partner (P < 0.001). According to multivariate analysis, the two factors most strongly related with violence were frequency of conflict with the partner and prohibitions imposed by the partner. CONCLUSIONS: Public health services are a good place to identify victims of domestic violence, and early detection and intervention programs should be established there. Services to support and protect victims should be expanded and strengthened in order to provide those persons with guidance, legal assistance, education, and job training. Appropriate alternative services for aggressors also need to be developed.

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OBJECTIVES: The aim of this study was to identify risk factors for physical abuse caused by male perpetrators, as well as to describe the context of abuse and the role of the female partner in these cases in Bogotá, Colombia. METHODS: Information from in-depth interviews of males reported to authorities for physical child abuse and their female partners (n = 45) was quantitatively and qualitatively analyzed and compared to to males and their female partners from the same neighborhood living with a child of the same gender and age (+/-3 years) as the abused child (n = 44). RESULTS: Situations of abuse occurred more often on a weekday, in the afternoon or early evening hours, with the mother present, exceptionally involved substance abuse, and tended to be repetitive. Male subjects' lower level of education, stepfather status, perceived stress, substance abuse and mental illness, lack of social support, history of childhood physical abuse, negative perceptions, attributions and unrealistic expectations of the child's behavior were associated with abuse. Cases' female partners were more likely to have a lower occupational level, a higher frequency of dependent personality, a history of childhood physical and sexual abuse and be herself physically and emotionally abused by her spouse. At least three scenarios for abuse emerged from the analyses: "explosive" men, "abusive disciplinarians," and "children out of parental control." CONCLUSIONS: Most of the findings are consistent with existing research despite the different social and cultural context. The different scenarios suggest the need to tailor preventive and rehabilitative interventions for abusers.

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Despite the ample literature on crime and violence, little research has been done outside English-speaking developed countries. Colombia has one of the highest homicide rates in the world. In order to identify individual factors related to resilience and vulnerability for violence and offending behavior in Colombia, we explored the life histories of 46 young men from high-risk families and compared those who had committed an offense to those who did not (resilient). The findings show that resilient men (compared to offenders) in Colombia have been less exposed to serious life stress, perceive stronger support from their families, narrate their past histories with greater detail and affect, and perceive greater degrees of control and coherence in their lives. The results are consistent with the existing literature and are interpreted within the framework of attachment theory.

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The prevalence of a variety of risk factors and their strength of association with a disease can vary greatly among apparently similar communities. In small communities, risk estimates can also vary from year to year. An identification of important risk factors in each community is then needed, so that interventions can be specifically oriented towards the needs of each specific community. The attributable risk is the adequate measure of association for these purposes. The purpose of this paper is to determine the minimum sample size required to detect a given attributable risk in cross-sectional studies. A table was constructed, presenting the number of exposed subjects necessary to detect a given attributable risk for different combinations of prevalence of disease and prevalence of exposure to a given risk factor, with a power of 0.80 and alpha of 0.05.

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Efforts are being made to extend the practice of Community Oriented Primary Care by reorienting existing health services or restructuring medical education curricula. Nevertheless, changes in education must be simultaneous to changes in health services so that health professionals trained in COPC will find areas to practice COPC. The experience described in this article presents an effort in these two directions. A teaching program was introduced in a traditional medical school curriculum and was extended to six health services by training the directors of the health service as teaching instructors of COPC or closely coordinating actions with the director of the health service. The results of the program show fulfillment of learning objectives and student satisfaction with the program. Evaluations of the development of COPC in the health services involved show modifications in health programs to meet community needs and stronger community leadership and organization.

PIP: Community Oriented Primary Care (COPC) emphasizes the individual and family and special needs population within a community setting in conformity with the Alma Ata Declaration of Health for All. The experiences of implementing COPC within the curriculum in a traditional medical school in Bogota, Colombia, are related. Training was also conducted in 3 urban and 3 rural locations, which were government health providers of primary care, influenced by a university close by, and had a committed, general practitioner available. Evaluations of students' perceptions of the course and the development of COPC were performed. The traditional medical school was the Jesuit-run Javeriana University, which was founded in 1942; the Department of Preventive Medicine and Social Medicine was restructured after 1984 due to evaluations which showed limited learning and negative attitudes. During the planning phase, the COPC theoretical model was defined, general learning objectives were identified, and teaching strategies selected. The COPC model was chosen because it integrated clinical with community practice and epidemiology with health services administration. Community participation was viewed as a mean to empower people through validating people's knowledge, broadening access to information and establishing cooperative relationships between health professionals and the people. The 10-week training program engaged 8 groups of 35 students during the initial 2 years of operation. Each group under the supervision of a tutor carried out a different phase of COPC. Care was both preventive and curative; programs were developed to modify risk factors for diarrheal disease, malnutrition, and respiratory disease. Participatory research is being conducted in 6 communities. The results of the students' evaluations show satisfaction with the program and learning objectives. Attitudes among students were changed, but whether these changes will continue into professional practice is unknown. The impact on health services showed that health programs were changed to reflect community needs; stronger community leadership and organization evolved. Problems were identified as lack of understanding of COPC applications, staff turnover, motivation, scarce resources, and people's attitudes of fatalism and paternalistic services.

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